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NPI Code Detail

MEDICARE: GEORGIA ANGELI SKELLY RD, MS, LDN

MEDICARE: GEORGIA ANGELI SKELLY RD, MS, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianL003962NC

General Provider Information

NPI Number : 1598022212
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGIA ANGELI SKELLY RD, MS, LDN
Provider Business Mailing Address
First Line : 1405 FLEMMING HOUSE ST
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-4662
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1405 FLEMMING HOUSE ST
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-4662
Country : US
Telephone Number : 919-435-8789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2012
Last Update Date : 04/19/2012

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